Welcome to your 5. 👶 Acute & Chronic Diarrhea, Dehydration, Malabsorption & Celiac Disease Arena — 40 MCQs
1.
A 2-year-old child presents with severe watery diarrhea and signs of significant dehydration. Laboratory investigations reveal low serum bicarbonate. Which mechanism best explains the acid–base disturbance?
2.
A 2-year-old child develops profuse watery diarrhea during a local outbreak of acute gastroenteritis. The child is dehydrated but remains conscious. Stool losses continue despite administration of oral rehydration solution. The parents believe ORS is ineffective because the diarrhea has not stopped. Which explanation best addresses their concern?
3.
A 9-year-old child with type 1 diabetes mellitus presents with unexplained iron-deficiency anemia and reduced height velocity. The child has no significant diarrhea or abdominal pain. Which approach is most appropriate?
4.
A 3-year-old child with acute watery diarrhea is prescribed oral rehydration solution (ORS). The mother asks how ORS can replace lost fluid even when diarrhea continues. Which intestinal mechanism explains its effectiveness?
5.
A 7-year-old child presents with chronic abdominal distension, loose stools and reduced linear growth. Celiac disease is suspected clinically. Which combination of investigations is most appropriate for initial serological assessment?
6.
A 6-year-old child presents with diarrhea lasting three months, intermittent abdominal pain, poor weight gain and occasional blood in the stool. Examination reveals pallor and mild abdominal tenderness. Laboratory investigations show elevated inflammatory markers. Which diagnosis should receive particular consideration?
7.
A 3-year-old child has frequent loose stools for several months. The parents report that stool frequency increases after consumption of large quantities of fruit juice. The child has normal physical activity, preserved appetite and stable growth percentiles. Which clinical feature most strongly supports a functional rather than malabsorptive disorder?
8.
A 3-year-old child presents with frequent loose stools for several months. The child remains active, eats normally and maintains appropriate weight and height for age. There are no signs of nutritional deficiency. Which diagnosis is most likely?
9.
A 6-year-old child presents with chronic diarrhea, abdominal bloating and poor weight gain. The parents report that the stools are occasionally greasy and difficult to flush. Stool testing is positive for Giardia. Which is the most likely diagnosis?
10.
A 10-month-old infant is admitted with severe diarrhea and dehydration. Serum sodium is markedly elevated. The infant is stabilized and requires continued fluid replacement under pediatric supervision. Which principle is particularly important during subsequent rehydration?
11.
A 6-year-old child with suspected celiac disease undergoes upper gastrointestinal endoscopy. Duodenal histology shows reduced villous height and increased crypt depth. Which clinical consequence would be expected from these changes?
12.
A 5-year-old child presents with chronic bulky stools, abdominal distension and poor linear growth. Hemoglobin is reduced, with a low mean corpuscular volume. Stool examination does not demonstrate intestinal parasites. Which interpretation best explains the hematological abnormality in the context of suspected intestinal malabsorption?
13.
A 5-year-old child presents with loose stools for three months, abdominal distension and poor weight gain. The stools are bulky, greasy and particularly offensive. Which underlying process most likely explains these findings?
14.
A 20-month-old child has had watery diarrhea for five days. The child is receiving ORS but has developed reduced appetite and mild weight loss. The mother has stopped giving complementary foods because she believes feeding will worsen the diarrhea. Which intervention is most appropriate?
15.
A 6-year-old child diagnosed with celiac disease is reviewed after one year of dietary treatment. The child has improved appetite, gained weight and shows improved height velocity. Repeat tTG-IgA levels have fallen considerably compared with baseline. Which interpretation is most appropriate?
16.
A 14-month-old child presents with watery diarrhea and repeated vomiting for three days. On examination, the child is irritable, has sunken eyes and drinks eagerly when offered fluids. The skin pinch returns slowly. After receiving supervised oral rehydration therapy, the child becomes alert, drinks normally and has improved skin turgor. What is the most appropriate next step in management?
17.
A 5-year-old child diagnosed with celiac disease has poor weight gain, pallor and reduced dietary intake. Investigations demonstrate iron deficiency and low vitamin D levels. Along with gluten exclusion, which intervention is most appropriate?
18.
A child with acute diarrhea is irritable, has sunken eyes and drinks water eagerly when offered. The skin pinch returns slowly. Which WHO dehydration classification is most appropriate?
19.
A 7-year-old child has confirmed celiac disease and has followed a gluten-free diet for eight months. Abdominal symptoms initially improved but have recently returned. Growth velocity remains below expected levels. The parents report regularly purchasing supposedly gluten-free bakery products from a shop that also processes wheat flour. Which is the most appropriate initial step?
20.
A 7-year-old child has newly confirmed celiac disease. The parents ask which long-term dietary intervention is necessary to prevent intestinal injury and allow normal growth. Which advice is most appropriate?
21.
A 4-year-old child develops frequent loose stools after an episode of gastroenteritis. The stools become more watery following milk consumption, with associated abdominal bloating. Which mechanism most likely explains these symptoms?
22.
A 5-year-old child with chronic diarrhea and growth failure is being investigated for suspected celiac disease. The parents have already stopped giving wheat-containing foods before the planned blood tests. Why might this interfere with diagnosis?
23.
A 15-month-old child presents with acute watery diarrhea of two days' duration. The child is alert, drinking normally and has no clinical evidence of dehydration. Which management approach is most appropriate?
24.
A 3-year-old child presents with acute watery diarrhea without blood in the stools. The child is mildly dehydrated but otherwise stable. There are no clinical features suggesting invasive bacterial infection. What is the most appropriate approach to antibiotic treatment?
25.
A 5-year-old child is diagnosed with celiac disease. Small-intestinal biopsy shows marked flattening of the mucosal villi. Which consequence of this structural abnormality most directly explains the child's nutritional deficiencies?
26.
A 3-year-old child presents with fever, abdominal pain and diarrhea for four days. The stools contain blood and mucus. The child appears unwell, with abdominal tenderness and reduced oral intake. Which diagnostic and therapeutic approach is most appropriate?
27.
A 9-month-old infant is brought with profuse watery diarrhea. The infant is lethargic, unable to drink adequately and has a very slow skin-pinch recoil. Which is the most appropriate initial management approach?
28.
A 4-year-old child presents with chronic diarrhea, abdominal distension, growth failure and iron-deficiency anemia. The symptoms began after the introduction of wheat-containing foods. Which diagnosis should be strongly suspected?
29.
A 5-year-old child is investigated for chronic diarrhea and growth failure. Tissue transglutaminase IgA is mildly elevated, and total serum IgA is normal. The parents request an immediate diagnosis of celiac disease without further assessment. Which response reflects appropriate diagnostic reasoning?
30.
An 8-year-old child with confirmed celiac disease has been advised to follow a gluten-free diet. At a follow-up visit, the parents explain that the child avoids bread but frequently eats foods prepared with the same utensils used for wheat-containing meals. Which counselling message is most important?
31.
An 8-year-old child with celiac disease has followed a gluten-free diet for six months. Abdominal symptoms have improved, and the parents want to know whether treatment is effective. Which approach is most appropriate for monitoring the child's progress?
32.
An 8-month-old infant presents with profuse watery diarrhea for two days. The infant is lethargic, has cold extremities, a weak peripheral pulse and prolonged capillary refill. Blood pressure is within the lower normal range for age. Which finding provides the strongest evidence that immediate circulatory stabilization is necessary?
33.
A 4-year-old child has chronic diarrhea, abdominal distension and poor weight gain. The parents independently started a gluten-free diet two months ago, and symptoms partially improved. The child is now referred for diagnostic confirmation of celiac disease. Which consideration is most important when planning further investigations?
34.
A 6-year-old child has chronic diarrhea, anemia and poor growth. Celiac serology shows a negative tissue transglutaminase IgA result, but total serum IgA is markedly reduced. Which interpretation is most appropriate?
35.
A 10-year-old child with celiac disease is attending school and feels embarrassed about eating different meals from classmates. The parents are concerned that strict dietary treatment may reduce the child's social participation. Which counselling approach best supports long-term management?
36.
An 18-month-old child develops watery diarrhea lasting more than two weeks following an acute gastrointestinal infection. The child continues to pass loose stools and has reduced weight gain. Which term best describes this diarrheal episode?
37.
A 10-month-old infant presents with watery diarrhea. The mother reports frequent loose stools, but the infant remains active, drinks normally and has no clinical signs of dehydration. According to WHO classification, which category best describes this child?
38.
A 4-year-old child has experienced loose stools and abdominal bloating for six weeks following an episode of infectious gastroenteritis. Symptoms occur mainly after milk consumption and improve when lactose-containing foods are temporarily reduced. The child has no blood in the stool or systemic inflammatory features. Which management approach best addresses the underlying disturbance?
39.
A 2-year-old child presents with sudden-onset watery diarrhea and vomiting for one day. Several children attending the same daycare have similar symptoms. The child has no blood in the stool and is clinically stable. Which is the most likely underlying cause?
40.
A 7-year-old child presents with abdominal distension, chronic loose stools and poor growth. Celiac serology is positive, and duodenal biopsy demonstrates villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes. Which pathological process best explains these findings?
